HL7.FHIR.US.DAVINCI-DRUG-FORMULARY\Drug tier of medication in health plan

DaVinci Payer Data Exchange (PDex) US Drug Formulary | STU2 Ballot
1.2.0 - STU2 Ballot

This page is part of the US Drug Formulary (v1.2.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

ValueSet: Drug tier of medication in health plan

Summary

Defining URL:

http://hl7.org/fhir/us/davinci-drug-formulary/ValueSet/DrugTierVS

Version:

1.2.0

Name:

DrugTierVS

Title:

Drug tier of medication in health plan

Status:

Active as of 12/3/21 6:37 PM

Definition:

The drug tier of a particular medication in a health plan. The base set are examples. Each plan may have its own controlled vocabulary.

Publisher:

HL7 Pharmacy Working Group

Source Resource:

XML / JSON / Turtle

References

Logical Definition (CLD)

Include all codes defined in http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS

Expansion

This value set contains 9 concepts

Expansion based on Codes for medication drug tiers in health plans v1.2.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS

Code	Display	Definition
generic	Generic	Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier.
preferred-generic	Preferred Generic	Commonly prescribed generic drugs.
non-preferred-generic	Non-preferred Generic	Generic drugs that cost more than drugs in ‘generic’ tier.
specialty	Specialty	Drugs used to treat complex conditions like cancer and multiple sclerosis. They can be generic or brand name, and are typically the most expensive drugs on the formulary.
brand	Brand	Brand name drugs that cost more than ‘preferred brand’ drugs.
preferred-brand	Preferred Brand	Brand name drugs
non-preferred-brand	Non-preferred Brand	Brand name drugs that cost more than ‘brand’ drugs.
zero-cost-share-preventative	Zero cost-share preventative	Preventive medications and products available at no cost.
medical-service	Medical Service	Drugs that must be administered by a clinician or in a facility and may be covered under a medical benefit.

Explanation of the columns that may appear on this page:

Level

A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance)

Display

The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code